Children’s Hospital sues state over exclusion from exchange plan networks

Seattle Children’s Hospital filed suit Friday over the state Office of the Insurance Commissioner’s “failure to ensure adequate network coverage” in several of the health plans sold on the state’s new online insurance marketplace, called Washington Healthplanfinder.

Most health plans now being sold through the state’s new health-insurance exchange do not include Seattle Children’s as an in-network provider. As a result, families that enroll in those plans could face significantly higher cost-sharing if they seek care at Children’s than if they seek care at the plans’ preferred providers.

The higher cost-sharing could seriously disrupt care for families currently receiving services at Children’s and could delay new patients from getting the specialized care they need, said Dr. Sandy Melzer, the hospital’s senior vice president and chief strategy officer.

Melzer said parents may be enrolling in health plans through the exchange without realizing that Children’s is not included in the plan’s network.

“The notion that a major insurance plan is going to exclude us from their network is truly precedent-setting and represents a new level of degradation in children’s access to care,” Melzer said.

Of the seven insurers offering plans in King County, only two – Group Health Cooperative and Community Health Plan of Washington – are offering plans through the exchange that include Seattle Children’s in their network.

The five in King County that do not include Children’s in their network are Premera Blue Cross, LifeWise Health Plan of Washington (a subsidiary of Premera), BridgeSpan (a subsidiary of Regence Blue Shield), Molina Healthcare and Coordinated Care.

Kaiser Foundation of Health Plan of Washington, which is offering plans only in Clark and Cowlitz counties, also does not include Seattle Children’s in its network.

Children’s is asking that the OIC reverse its decision to allow Molina and Coordinated Care to sell plans on the exchange as long they do not include the hospital in their networks.

OIC spokeswoman Stephanie Marquis says the OIC takes concerns about access to care seriously. “We are reviewing Children’s petition to see what lies at the heart of their concerns and will see how it gets resolved through the legal process,” she said.

About the blog

HealthCare Checkup is a new blog dedicated to helping readers understand the Affordable Care Act and how the federal health-care law affects everyone – insured or not. Reporters in Seattle, Olympia, and Washington, D.C. contribute. The editors are Beth Kaiman and Mark Watanabe.

The blog is produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation, a health policy research and communication organization that is not affiliated with Kaiser Permanente.